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CORF

  1. DDx for distal radius lytic expansile lesion
    • GCT
    • Chondroblastoma
    • Clear cell chondrosarc
    • ABC
    • Chondromyxoid fibroma
    • Teleangectatic osteosarc
  2. Location biopsy of distal radius lesion
    Second compartment bc wrist fusion s salvage procedure
  3. Management of GCT of distal radius
    Expansile with soft tissue component: Wrist fusion in young

    If non expansile: Extended intra-lesional curettage and bone grafting
  4. Extended intralesioal curetage adjuncts 3
    • Argon beam
    • Cryotherapy
    • Phenol
  5. 6 prognostic factors for bone sarcoma
    • size > 8
    • LDH
    • Alk phos
    • Mets
    • Age
    • Response to chemo: more than 90%
  6. 5 tests to order for a suspected malignant primary bone tumor
    • MRI entire bone
    • CT chest
    • Bone scan/PET
    • Bloods: LDH, ALP, extended lytes, ESR, CRP
    • Full lenght x rays
  7. DDx of well circumscribed lytic lesion femoral neck 6
    • Osteoblastoma
    • Chondroblastoma
    • Chondromyxoid fibroma
    • ABC
    • Fibrous dysplasia
    • Infection
  8. Biopsy of femoral head/neck lesion approach
    Lateral subtrochanteric attempting to spare the abductor/GT
  9. DDx aggressive looking lytic lesion with periosteal reaction in proximal humerus in 11 yo
    • Ewing
    • Osteosarcoma
    • Infection
  10. Biopsy location of proximal humerus
    Anterolateral approach within brachialis
  11. Surgical management of proximal humerus ewings sarcoma
    Proximal humerus endoprosthesis
  12. 3 reasons to use radiation for ewing sarcoma
    • Axial/pelvic with high morbidity surgery
    • Positive margins
    • Poor response to chemotherapy
  13. Chemo for osteosarcoma 3
    • Cisplatin
    • Doxyrubicin 
    • Methotraxate
  14. Management of hypercalcemia
    • Calcitonin
    • Loop diuretics
    • Bisphosphonates
    • NS fluid hydration for fluid expansion
  15. well circumscribed lytic lesion in epiphysis of skeletally immature ddx 3
    • Chondroblastoma
    • Clear cell chondrosarcoma
    • Infection
  16. Neoadjuvant radiotherapy advantages and disadvantages
    Advantages: smaller field, smaller dose.

    Disadvantage: Higher rate of wound complications
  17. Biopsy site: prox humerus
    Mid humerus
    Distal humerus
    Proximal radius
    Distal radius
    Prox femur
    Distal femur
    Proximal tibia
    Pelvis
    Ischium
    • Mid ant deltoid
    • Anterolateral
    • Posterolateral
    • Posterior: boyd
    • Second compartment
    • Transtrochanteric
    • Anteromedial
    • Anteromedial: subq border
    • CT guided:if not ilioinguinal through rectus
    • Through hamstring lithotomy
  18. atypical femur fracture parameters
    Need 4 major criteria

    • transverse or short oblique
    • Low energy mechanism
    • Medial spike
    • No comminution
    • From LT to supracondylar region
  19. Describe placement of elbow external fixator
    2 pins anterolateral humerus: mini open approach dissect down to done

    2 pins on ulna: subcutaneous border
  20. Describe tendon transfer for radial nerve
    • PT to ECRB
    • FCU to EDC
    • PL to EPL
  21. Cervical spine issues: what to ask in history
    • PMHx
    • Meds
    • Allergies
    • Smoking
    • Pain quality
    • Constitutional symptoms
    • Bowel or bladder
    • Trauma
    • Signs myelopathy: Loss fine motor, changes in gait
  22. Physical exam for cervical myelopathy
    • ROM
    • Babinski
    • Reflexes
    • Detailed neurologic
    • Romberg
    • Inverted brachioradialis
    • Hoffman
    • Clonus
    • Cerebellar: rapid alternating motion
  23. X ray finding of myelopathy with OPLL, what investigation to order
    • CT: assess OPLL
    • MRI: Assess myelopathy
  24. Name 3 possible options for treating OPLL
    • POsterior decompression and fusion: need kyphosis <11
    • Laminoplasty
    • Multilevel ACDF
  25. Laminoplasty: 2 advantage
    2 disadvantages
    • Increase volume of spinal canal
    • Motion preserving procedure

    No need for laminoplasty in person with no motion
  26. What is the risk of cervical laminectomy
    Post laminectomy kyphosis
  27. Treatment of tuberculosis 4
    • Isoniazid
    • Rifampin
    • Ethambutol
    • Pyazanamide
  28. x ray findings of rheumatoid spine 3 broad categories
    • Basilar invagination
    • Ranawat c1-c2 index: lie across anterior and posterior arc C1. Perdendicular line from C2 pedicle should be >13

    McGregor line: Line from hard palate to caudal posterior occipital condyle. Tip of dens should be < 4.5 mm away from this

    Chamberlain line:Posterior edge hard palate to posterior foramen magnum.. dens should be <5mm proximal to it

    McRae line: if dens does not cross line drawn across foramen magnum, there is no basilar invagination

    • C1-C2 instability
    • ADI: should be <3.5mm...indication for surgery is >10mm
    • PADI: should be >14

    • Subaxial instability
    • If > 4mm or 20% VB translation, risk for neuro
  29. 3 types of instability of rheumatoid spine
    • Subaxial: >4mm or 20% translation on flex ex
    • C1-C2 intability
    • Cranial settling: same thing as basilar invagination
  30. Describe classification for Rheumatoid spine
    Ranawat spine

    • Class 1: Pain and no neuro deficit
    • Class 2: Subjective weakness, UMN signs
    • Class 3a: Objective weakness, UMN, ambulatory
    • Class 3b: Objective weakness, UMN, non ambultory
  31. Principles of cervical spine deformity
    • Restore alignment
    • Decompress neuro elements
    • Stabilize
  32. 4 surgical options for c1-c2 instablity
    • Harms: C1 lateral mass and C2 pedicle
    • Transarticular screw
    • Laminar screws
    • Wire: gallie
  33. Describe surgery for cauda equina caused by disc
    • Midline approach
    • Wide pedicle to pedicle decompression
    • Discectomy
    • Close in layers
  34. Describe management of a dural tear
    • Bed rest x 48 hrs
    • Consider placement lumbar drain intra op

    • Surgical
    • Put in trendelenberg
    • Attempt watertight closure of tear with 5-0 nonabsorbable
    • Supplement t-seal
    • Check with valsalva manouver
  35. NOMS criteria for spine mets
    • Neurology assessment
    • Oncology assessment
    • Mechanical assessment
    • Systemic assessment
  36. Approach to do corpectomy in lumbar spine
    Anterior retroperitoneal: watch out for iliolumbar vein
  37. 4 indications for surgery in tumor of the spine
    • Instability/deformity
    • Need for diagnosis
    • Pain not controlled with non op
    • Neurological deficit
  38. X ray findings of TB spine
    • Preservation of disc space
    • soft tissue mass
    • Deformity of endplates
  39. Diagnostic test for TB
    SPutum acid positive for acid fast bacilli
  40. 2 criteria for closed reduction of c spine dislocation
    • Awake, cooperative patient with reliable physical exam
    • Monitored setting
  41. Described steps for closed reduction of jumped facets
    • Traction applied with gardner wells
    • 10 lbs for head
    • 5 lbs per level
    • Repeated physical exam and x ray after reduction
  42. 3 indications to stop adding weight to gardner wells
    • Succesful reduction
    • Over distraction
    • neuro deterioration
  43. describe 4 complications to Anterior approach to spine
    • Esophageal perforation
    • recurrent laryngeal nerve
    • dysphagia
    • hematoma leading to airway compromise
  44. 5 post op consideration for patients with SCI
    • DVT prophylaxis
    • Pressure ulcer prevention
    • Keep MAP elevated
    • Bowel and bladder regiment
    • Rehab OT/PT
  45. 2 structures to preserve when doing decompression
    • Facet joint
    • Pars
  46. assessment of growth remaining for scoliosis 6
    • X ray
    • Risser stage
    • Olecranon apophysis 
    • Hand ossification

    • Clinical
    • Tanner stage
    • Peak height velocity
    • Pre/post menarchal
  47. what to do if loss of spinal monitoring during scoli
    • Correct hypotension and elevate MAP
    • Ensure that not paralyzed: No inhalational agents
    • Ensure normothermia
    • Check monitoring leads
    • Wake up test
    • Undo last correction/remove rods
    • Put a rod in situ to correct stability
  48. Anatomical and physiologic differences btw adult and peds  6
    • Large epiglottis
    • Anterior larynx
    • Need breslow tape to measure for medications
    • Increase likelyhood intra-abdominal because not covered by rib
    • More likelyhood cardiac and pulmonary injuries
    • Ligamentous laxity: pseudosubluxation
    • Big head
  49. 5 risk factors DDH
    • First born
    • Female
    • Frank breech
    • Family history
    • Oligohydramnios
  50. 3 clinical exam findings associated with DDH
    • Congenital torticollis
    • Metatarsus adductus
    • Plagiocephaly
  51. 3 things on inspection to see DDH
    • Asymmetric skin fold
    • LLD
  52. 3 physical exam test for DDH in newborn
    • Barlow
    • Ortolani
    • Galeazzi
  53. Describe imaging findings of ultrasound for DDH 3
    • Alpha angle: normal >60
    • Beta: < 55
    • Line bisects > 50% femoral head

    • Good quality if ileum is straight
    • The neck of the femur is visualized
    • See the ischium
  54. Describe application of pavlik harness
    • Strap across chest
    • Shoulder straps
    • Stirrups
    • Flexion straps: 90-100
    • Abduction: 45-60
  55. 3 complications of pavlik harness use
    • AVN
    • Femoral nerve palsy
    • Pavlik harness disease: develop global displasia bc it erodes posterior wall
  56. 5 things on history to dx CP
    • Maternal viral illness
    • Uterine hypoxia
    • Asphyxia
    • Low apgar score
    • Prematurity
  57. 3 physical exam findings for CP
    • Hyperreflexia
    • Velocity dependent spasticity
    • Contractures
  58. Diagnosis of CP
    MRI brain: periventricular leukomalacia
  59. Name of gait with child with diplegia
    Jumping gait
  60. Medical considerations of CP 3
    • GI: gastroparesis
    • Cardiac problems
    • Epilepsy
  61. Medical management of CP
    • Botox
    • Baclofen
    • Physio
  62. When to do hip surveillance in CP
    GMFCS 4-5
  63. 5 x ray findings SCFE
    • Kleins line doesn't intersect epiphysis
    • Metaphyseal blanch sign steel
    • Increased southwick angle
    • Superior and anterior displacement of the femur
    • Widening of the physis
  64. 5 risk factors for scfe
    • Obesity
    • Endocrinopathy
    • Radiation
    • Male
    • Contralateral SCFE
  65. How do you classify scfe based on severity, timing, stability
    Southwick angle

    • <30
    • 30-50
    • >50

    • Loder
    • Stable
    • Unstable

    • Timing
    • Acute <3 weeks
    • Acute on chronic
  66. 4 factors to pin other hip
    • Unable to have reliable follow up
    • Endocrinopathy
    • Young age
    • Obesity
  67. How to do Dunns view
    45 degrees flexion and neutral rotation, 20 degrees abduction
  68. Describe pirani scoring for clubfoot
    • Hindfoot
    • Posterior crease > 0
    • Empty heel > 0.5
    • Rigid Equinus > 1

    Mid foot

    • Medial crease > 0
    • Curvature of lateral border >0.5
    • Position of head talus > 1
  69. Steps of PMR for clubfoot
    • FInd NV bundle
    • Achilles lenghtening
    • Release tibio talar and subtalar joint
    • Release peroneal sheath
    • Find tib ant and release TN joint
    • Lengthen Tib post, FHL, FDL at knot of henry
    • Spring ligament
    • Do not release deltoid
  70. 4 risk factors Perthes
    • Second hand smoke
    • Low birth weight
    • Male
    • Contralateral perthes
  71. 4 stages of perthes
    • Initial
    • Fragmentation
    • Reossification
    • Remodelling
  72. Describe radiographic system that has prognostic value in perthes
    Herring

    • A: normal lateral column height
    • B: <50% loss of height
    • B/C: 50% loss height
    • C: >50% loss height
  73. Patient presents with bow legs: what to ask on history
    • History/Fam hx of SED/MED
    • Age of walking: early walking risk factor
    • Getting better or worse
  74. 3 diagnosis associated with CVT
    • Arthrogryposis
    • Larsen syndrome
    • Myelomeningocele
  75. DDx of genu varum
    • Rickets
    • Skeletal dysplasia
    • Blounts
    • OI
  76. 4 risk factors for distal bicep tear
    • Steroids
    • Fluoroquinolone
    • Male
    • DM
    • Smoking
  77. 3 physical exam findings distal bicep tear
    • +ve hook test
    • Popeye sign
  78. Describe interval in anterior approach to antecubital fossa
    • Pronator teres: Median nerve
    • Brachioradialis: Radial nerve
  79. How to avoid pin injury in distal bicep repair
    • Keep supinated when working from the front
    • Avoid placement of retractor in neck of radius
  80. Muscles innervated by PIN
    • EDC
    • ECU
    • EPL
    • EPB
    • Abductor pollicis longus
    • EDC
    • EIP
    • EDM
    • ECRB
    • Supinator
  81. 4 ways to prevent popliteal injury in transtibial PCL reconstruction
    • use curette to catch k wire
    • 70 degree score
  82. what is the normal alpha angle
    < 42
  83. name 3 portals used for hip arthroscopy and dangers
    • Anterior: LFCN
    • ANterolateral: CGN
    • Posterolateral: Sciatic nerve
  84. What parameter of resection is shown to predict risk of post op osteoplasty femoral neck
    Depth less than 30%
  85. Classification of charcot foot
    Brodsky

    • Type 1: TMT and Naviculo cuneiform >>rocker bottom foot
    • Type 2: ST, TN, CC
    • Type 3A: TT
    • Type 3B: post fracture of calcaneous tuberosity
    • Type 4: combination
    • Type 5: Isolated forefoot
  86. Stages of charcot foot
    • Stage 0: joint edema, normal x rays
    • Stage 1: fragmentation
    • Stage 2: Coalescence
    • Stage 3: Reconstruction
  87. 5 complications diabetic ankle fracture
    • Non union
    • Malunion
    • Infection
    • Loss fixation
    • Hardware failure
  88. 5 ways to improve fixation in ankle fracture in compromised host
    • Fixation to tibia
    • Locking plate
    • Bigger plate
    • Plate on medial side
    • Augment ex fix
    • transarticular fixation
  89. list 3 ways to improve safety with HIV hep c
    • Optimize viral load
    • Kevlar gloves
    • Space suit
  90. Describe monofilament test
    Semmes-weinstein monofilament testing

    5.07 length 10G nylon test if sensation preserved when monofilament bends
  91. 3 ortho manifestations of CMT outside foot
    • Hand clawing
    • DDH
    • Scoliosis
  92. 2 clinical presentations of cavus foot
    • Recurrent instability
    • Base 5th MT #: lateral column overload
  93. Bony surgery for Cavovarus foot
    • Dorsiflexion
    • Lateral calc slide

    If arthritic: Triple fusion
  94. Soft tissue surgery for Cavovarus
    • Plantar fascia release
    • Peroneous longus to brevis
    • Tib post to lateral cuneiform
    • Lateral ligament reconstruction
  95. 3 intrinsic causes of hallux valgus
    • Cerebral palsy with muscle inbalance
    • Pes planus
    • Ligamentous laxity
    • Rheumatoid arthritis
  96. 3 non op modalities for hallux valgus
    • Spacer btw toes
    • Wide boxed shoes
    • Orthotics
  97. Describe normal parameters for Hallux valgus
    • IMA: < 9
    • HVA: <15
    • DMAA: <10
  98. 3 features of juvenile hallux valgus
    • Ligamentous laxity
    • Increased DMAA
    • Metatarsus primus varus
  99. 5 relative indications for 1st MTP fusion in hallux valgus
    • Arthritis
    • Large deformity
    • Hypermobile
    • CP
  100. Describe position of fusion for Hallux valgus
    Dorsal incision

    • Position: 15 degrees relative to floor
    • 10-15 degrees of valgus neutral rotation
  101. 4 reasons for metatarsalgia in RA
    • Plantar dislocation MTP
    • Sinovitis MTP
  102. diagnostic criteria of RA
    • Morning stiffness >1hr
    • Swelling > 3joints
    • Rheumatoid nodules
    • X ray changes in the hand: bony erosions
    • Systemic arthritis
    • Serum rheumatoid factor
    • Arthritis of MCP and PIP and wrist
  103. Describe surgery for RA
    • Check c spine
    • Stop medication

    • Cascading resection of MTP heads
    • Release of lenghten EDL/release EDB and do fdl/fds at the level of metatarsal head
    • PIP fusion or tendon transfer like a fowler
    • Fusion 1st MTP: 15/15 degrees

    Incisions: 3 incisions
  104. Hammer toes: if rigid
    Rigid: Fusion transverse incision
  105. Describe a functional rehab protocol for acute achilles tendon rupture
    • 0-2 wks: Initial immobilization + NWB
    • 2-4 wks: CAM (control ankle motion) + 2 cm heel lift + Protected weight bearing + ROM to neutral
    • 4-6 wks: WBAT
    • 6-8 wks: remove heel lift + Dorsiflexion stretching + Propioception
    • 8-12 wks: Wean off boot
  106. Describe VY advancement for chronic achilles
    Longitudinal incision while protecting sural nerve

    Measure gap to close: must be < 3 cm

    Length of V is twice length of gap

    Apex proximal

    Repair of achilles and reinforce
  107. DDx adult flatfoot 3
    • Tib post insufficiency
    • Tarsal coalition
    • Post traumatic: From missed lisfranc
    • Idopathic
    • Charcot foot
  108. Classification of tib post inufficiecy
    • 1: Normal x rays Painful single heel raise > tenosynovectomy
    • 2: Flexible deformity > unable to do single heel raise
    • 3: Rigid deformity
    • 4: Deltoid incompetence
  109. ddx for pain after calc #
    • Subtalar OA
    • Subtalar impingement
    • Non union
    • Malunion
    • Peroneal tendon tear
  110. Describe brodens view
    Ankle in neutral location and 45 degrees of IR

    Take x rays at 40, 30, 20, 10
  111. 5 non op for calc #
    • Physio
    • Injection
    • NSAID's
    • Orthotics
  112. Describe a distraction subtalar arthrodesis
    For calc malunion with loss of height

    • Posterolateral approach: btw fhl and peroneals
    • Laminar spreader structural bone graft to restore height of talus
  113. 5 complications of iliac crest bone graft
    • Neuroma
    • CRPS
    • Pain
    • Hematoma
    • Infection
    • Fracture
  114. Define vaughn-jackson syndrome
  115. DDx Vaughn-Jackson
    • Subluxation MCP
    • Sagital band rupture
    • PIN palsy: caused by radiocapitellar joint
  116. What physical exam finding helps you confirm vaughn jacksn
    In vaughn jackson there is loss of tenodesis effect with wrist flexion: rules out PIN

    Should be able to do resisted extension after fingers brought passively in extension: isolates sagital band
  117. Good lateral x ray of wrist
    Pisiform overlies distal third of scaphoid
  118. Treatment of vaughn  jacksons
    Semi acute

    Tendon transfer: EIP to EDC 5 and tenodesis EDC 3-4

    Darrach

    Check tension by looking at tenodesis effect
  119. Vaughn-jackson sequence of events
    Attritional rupture EDM, EDC ring and small
  120. RA with wrist OA and CMC OA and pain: treatment
    Wrist fusion and MCP Arthroplasties in a staged fashion

    Start Proximal: after wrist fusion MCP deformity gets worse....will help you only do tension of mcp soft tissue once
  121. RA hand things to thing about
    • MCP volar subluxation
    • Vaughn jackson
    • PIN palsy: RC joint
    • CMC arthritis
  122. Classic RA hand deformity
    Wrist points radial and supinated and volar translated

    MCP: Radial sagittal band attrition
  123. Position of wrist fusion
    • 3 ray in line with radius
    • 10-15 degrees of extension and 5-10 ulnr deviation
  124. PRC in wrist fusion: advantages and disadvantages
    Advantages: Easier to correct a deformity. Additional bone graft.

    Disadvantage: Does  not maintain length
  125. PLRI physical exam
    • Push off test
    • Pivot shift
    • Getting up from chair
  126. Keinboch stages
    • Stage 1: No x ray changes,MRI changes
    • Stage 2: Lunate sclerosis
    • Stage 3a: Lunate collapse with normal scaphoid rotation
    • Stage 3b: Lunate collapse with rotation scaphoid
    • Stage 4: Adajcet degeneration
  127. How to access the DRUJ
    Through floor of 5th compartment
  128. Madelung: ligament affected
    VIckers ligament
  129. Madelungs: syndrome associates
    Leri-Weill dyschondosteosis
  130. Procedure for madelung in skeletally immature
    Excision of bony bar: vickers ligament and fat interposition

    +/- ulnar epiphysiodesis
  131. Procedure for madelung in skeletally mature
    • Dome osteotomy
    • Ulnar shortening

    Failed the 2 above: Radioscapholunate fusion and distal scaphoid excison
  132. Typical x ray finding of ulnocarpal impaction
    Cysts in ulnar aspect of lunate
  133. Shoulder options for rotator cuff arthropathy
    • Oversized hemi
    • RSA
    • Fusion
  134. What ligament of shoulder protects you from antero-superior escape
    CA ligament
  135. Causes of acetabular protrusio 4
    • Marfans
    • Pagets
    • Idiopathic
    • Post-tramatic
  136. Characteristics of cement
    • Elution properties
    • Appropriate spectrum
    • Favourbale toxicity and systemic side effect
    • Cannot compromise structural intergity 
    • Heat stable
    • Cost
Author
egusnowski
ID
345817
Card Set
CORF
Description
Corf
Updated

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